Brown tumors are rare, found in only 0.1% of hyperparathyroidism cases, and even less common in tertiary hyperparathyroidism involving multiple facial bones. They typically affect women over 50 years old, which contrasts with this patient’s profile. A 24-year-old male with chronic kidney disease presents with a progressively enlarging brown tumor of the maxilla and mandible causing displacement of the teeth and facial deformity. Skeletal abnormalities, including bowing of shoulders, clubbing of fingers and loss of height were present.

Biopsy of the mass revealed ossifying fibroma and imaging revealed widespread lytic changes in the calvarium and orbits. Bone mineral densitometry showed osteoporosis, ionized calcium and phosphorus were normal but intact PTH was markedly elevated.

Parathyroid scintigraphy identified a hyperfunctioning parathyroid adenoma, which was surgically excised via right inferior parathyroidectomy via gamma probe guided localization. Intraoperative parathyroid hormone (PTH) levels decreased from 5140 pg/mL to 1754 pg/mL (normal 18.50-88.0) ten minutes post-excision. Histopathology confirmed the diagnosis of a parathyroid adenoma. Post operatively, hungry bone syndrome was managed with calcium supplement and dialysis. Follow up revealed a reduction in tumor size and normalization of intact PTH and calcium levels, resulting in an improvement in the patient’s quality of life.

This case illustrates a rare presentation of multiple brown tumors in a young male with tertiary hyperparathyroidism. Surgical excision of the adenoma and appropriate postoperative care can yield favorable outcomes.